Diffuse bone marrow serous atrophy

Case contributed by Dr Sammy Tawk

Presentation

Patient with known anorexia nervosa presented to the emergency department for non-tender left lower limb swelling.

Patient Data

Age: 30 years
Gender: Female
X-ray

Left ankle:

Diffuse subcutaneous oedema with loss of soft tissue/fat plane demarcation. Bone demineralization.

 

Ultrasound

Left lower limb:

Diffuse subcutaneous oedema with heterogeneous appearance of the muscles. No evidence of venous thrombosis.

Diffuse high signal intensity of the subcutaneous fat and the bone marrow of both lower limbs on STIR sequence with corresponding homogenous intermediate signal on T1 weighted sequence. Note the swollen left lower limb compared to the right one.

Case Discussion

This case demonstrates the abnormal MRI signal intensities known as the "flip flop" effect that can be seen in severe anorexia nervosa.

Note that due to theses MRI signal abnormalities, an insufficiency fracture can be easily overlooked.

Case courtesy of Dr Pierre TRITSCHLER

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Case information

rID: 56270
Case created: 23rd Oct 2017
Last edited: 6th Nov 2017
Inclusion in quiz mode: Included

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